INTRODUCTION: EUS has been shown to be an accurate modality for detecting and staging pancreatic cancer. EUS characteristics of cystic/mucinous tumors of the pancreas have received limited study. AIM OF STUDY: To characterize the EUS criteria of cystic/mucinous tumors. METHOD: Our EUS database identified 37 patients diagnosed with cystic/mucinous tumors as follows: 14 had mucinous cystadenocarcinomas (MCA), 13 were intraductal papillary carcinomas (IPC), 6 had benign mucinous duct ectasia (MDE), 2 had intraductal mucinous hyperplasia (IMH) and one patient had microcystic cystadenoma (MA). We correlated EUS findings to pathology/FNA cytology in all patients. In this group, 27 (73%) had surgical correlation and in 10 patients EUS guided FNA made the diagnosis. We then compared our findings to 20 random patients previously diagnosed with pancreatic ductal carcinoma (PDC) and staged with EUS and surgery. RESULTS: MCA IPC MDE IMH MA PDC (n=14) (n=13) (n=7) (n=2) (n=1) (n=20) Hypoechoic cystic/solid mass +++ +++ +++ + Complex cyst ++ Hypoechoic mass +++ ++ +++ Echogenic Foci + + + ++ + Dilated MPD ++ ++ +++ +++ + Hyperechoic Thickened MPD + +++ ++ Mucin Plug + L N Mets + + ++ +++=Most prominent feature; ++=2nd less prominent; +=3rd least prominent. SUMMARY:. MCAs are characterized by a hypoechoic cystic/solid mass or complex cyst and dilated MPD. IPCs appear as hypoechoic cystic/solid mass or hypoechoic mass and a dilated MPD +/- thickened hyperechoic duct borders. MDE appears as a markedly dilated MPD with hyperechoic thickening of the duct wall. IMH appears as a dilated and thickened MPD +/hypoechoic mass. MA presents as a cystic/solid mass with regular outer border and echogenic foci. One PDC presented as a cystic/solid mass, echogenic foci and a mildly dilated MPD. CONCLUSIONS: EUS criteria exist that can differentiate cystic neoplasms. PDC can rarely mimic a cystic tumor on EUS. Large blinded series are needed to determine sensitivity and specificity when utilizing the above noted tumor features.
ASJC Scopus subject areas
- Radiology Nuclear Medicine and imaging